Skin closure with Pfannenstiel incision in lower segment caesarean section; comparison of wound outcome with interrupted vs. subcuticular techniques

Abstract

Introduction: Caesarean section is the most common surgical procedure performed in the world. A vast majority of the procedures are carried out with Pfannenstiel incision. Different techniques and materials are used to approximate the skin in caesarean section. Each method has its own advantages and disadvantages. The objective of the study was to compare surgical wound outcome and satisfaction of women who underwent Pfannenstiel incision closure with interrupted vs. subcuticular suturing in caesarean sections. Methods: A prospective comparison was carried out in 400 age and body mass index matched women who underwent lower segment caesarean section for the first time. Standard lower segment caesarean section was performed with assigning interrupted and subcuticular wound closure for 200 women in each group, following matching for BMI and age. Two arms were compared for wound complications, postoperative pain and overall satisfaction of the outcome. Results: There was no statistically significant difference between groups for baseline characteristics (age, BMI and category of caesarean sections). According to visual analogue scale 91% of women reported to have moderate to severe pain in interrupted group compared to 80% in subcuticular group (p<0.05). Wound complications were present in 8% of interrupted group vs 3% in subcuticular group (p<0.001). Sixty four percent of women were satisfied with subcuticular method vs. 28% with interrupted method (p<0.001). Conclusions: Women who had subcuticular suturing method had less post-operative pain, better wound outcome and more satisfaction compared to interrupted suturing.